Browse > Article
http://dx.doi.org/10.3340/jkns.2015.57.1.23

The Influence of Pituitary Adenoma Size on Vision and Visual Outcomes after Trans-Sphenoidal Adenectomy : A Report of 78 Cases  

Ho, Ren-Wen (Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine)
Huang, Hsiu-Mei (Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine)
Ho, Jih-Tsun (Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.57, no.1, 2015 , pp. 23-31 More about this Journal
Abstract
Objective : The aims of this study were to investigate the quantitative relationship between pituitary macroadenoma size and degree of visual impairment, and assess visual improvement after surgical resection of the tumor. Methods : The medical records of patients with pituitary adenoma, who had undergone trans-sphenoidal adenectomy between January 2009 and January 2011, were reviewed. Patients underwent an ocular examination and brain MRI before and after surgery. The visual impairment score (VIS) was derived by combining the scores of best-corrected visual acuity and visual field. The relationship between VIS and tumor size/tumor type/position of the optic chiasm was assessed. Results : Seventy-eight patients were included (41 male, 37 female). Thirty-two (41%) patients experienced blurred vision or visual field defect as an initial symptom. Receiver operating characteristic curve analysis showed that tumors <2.2 cm tended to cause minimal or no visual impairment. Statistical analysis showed that 1) poor preoperative vision is related to tumor size, displacement of the optic chiasm in the sagittal view on MRI and optic atrophy, and 2) poorer visual prognosis is associated with greater preoperative VIS. In multivariate analysis the only factor significantly related to VIS improvement was increasing pituitary adenoma size, which predicted decreased improvement. Conclusion : Results from this study show that pituitary adenomas larger than 2 cm cause defects in vision while adenomas 2 cm or smaller do not cause significant visual impairment. Patients with a large macroadenoma or giant adenoma should undergo surgical resection as soon as possible to prevent permanent visual loss.
Keywords
Ophthalmologic surgical procedures; Pituitary adenoma; Visual fields; Visual impairment;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Fluss R, Faraggi D, Reiser B : Estimation of the Youden Index and its associated cutoff point. Biom J 47 : 458-472, 2005   DOI
2 Krisht AF : Giant invasive pituitary adenomas : management plan. Contemp Neurosurg 21 : 1-5, 1999
3 Mortini P, Barzaghi R, Losa M, Boari N, Giovanelli M : Surgical treatment of giant pituitary adenomas : strategies and results in a series of 95 consecutive patients. Neurosurgery 60 : 993-1002; discussion 1003-1004, 2007   DOI
4 Thomas R, Shenoy K, Seshadri MS, Muliyil J, Rao A, Paul P : Visual field defects in non-functioning pituitary adenomas. Indian J Ophthalmol 50 : 127-130, 2002
5 Ebersold MJ, Quast LM, Laws ER Jr, Scheithauer B, Randall RV : Longterm results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 64 : 713-719, 1986   DOI
6 Roelfsema F, Biermasz NR, Pereira AM : Clinical factors involved in the recurrence of pituitary adenomas after surgical remission : a structured review and meta-analysis. Pituitary 15 : 71-83, 2012   DOI
7 Anderson D, Faber P, Marcovitz S, Hardy J, Lorenzetti D : Pituitary tumors and the ophthalmologist. Ophthalmology 90 : 1265-1270, 1983   DOI
8 Anderson DR :Perimetry : With and Without Automation, ed 2. St. Louis : Mosby, 1987
9 Chang EF, Zada G, Kim S, Lamborn KR, Quinones-Hinojosa A, Tyrrell JB, et al. : Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas. J Neurosurg 108 : 736-745, 2008   DOI
10 Ciric I, Ragin A, Baumgartner C, Pierce D : Complications of transsphenoidal surgery : results of a national survey, review of the literature, and personal experience. Neurosurgery 40 : 225-236; discussion 236-237, 1997   DOI
11 Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J : Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery 17 : 446-452, 1985   DOI
12 Colao A, Di Somma C, Pivonello R, Faggiano A, Lombardi G, Savastano S : Medical therapy for clinically non-functioning pituitary adenomas. Endocr Relat Cancer 15 : 905-915, 2008   DOI
13 Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. : The prevalence of pituitary adenomas : a systematic review. Cancer 101 : 613-619, 2004   DOI
14 Fahlbusch R, Schott W : Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale : surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96 : 235-243, 2002   DOI
15 Ferrante E, Ferraroni M, Castrignano T, Menicatti L, Anagni M, Reimondo G, et al. : Non-functioning pituitary adenoma database : a useful resource to improve the clinical management of pituitary tumors. Eur J Endocrinol 155 : 823-829, 2006   DOI
16 Foroozan R : Chiasmal syndromes. Curr Opin Ophthalmol 14 : 325-331, 2003   DOI
17 Garibi J, Pomposo I, Villar G, Gaztambide S : Giant pituitary adenomas : clinical characteristics and surgical results. Br J Neurosurg 16 : 133-139, 2002   DOI
18 Gnanalingham KK, Bhattacharjee S, Pennington R, Ng J, Mendoza N : The time course of visual field recovery following transphenoidal surgery for pituitary adenomas : predictive factors for a good outcome. J Neurol Neurosurg Psychiatry 76 : 415-419, 2005   DOI
19 Goel A, Nadkarni T, Muzumdar D, Desai K, Phalke U, Sharma P : Giant pituitary tumors : a study based on surgical treatment of 118 cases. Surg Neurol 61 : 436-445; discussion 445-446, 2004   DOI
20 Hennessey JV, Jackson IM : Clinical features and differential diagnosis of pituitary tumours with emphasis on acromegaly. Baillieres Clin Endocrinol Metab 9 : 271-314, 1995   DOI
21 Hollenhorst RW, Younge BR : Ocular manifestations produced by adenomas of the pituitary gland : analysis of 1000 cases in Kohler PO, Ross GT (eds) : Diagnosis and Treatment of Pituitary Tumors. Amsterdam : Excepta Medica, 1973, pp53-63
22 Ikeda H, Yoshimoto T : Visual disturbances in patients with pituitary adenoma. Acta Neurol Scand 92 : 157-160, 1995
23 Jaeger W, Thomann H :[German Ophthalmological Association. Recommendations for evaluation of reduced earning capacity caused by damage to vision. September 1981]. Klin Monbl Augenheilkd 180 : 242-244, 1982   DOI
24 Jaffe CA : Clinically non-functioning pituitary adenoma. Pituitary 9 : 317-321, 2006   DOI
25 Kerrison JB, Lynn MJ, Baer CA, Newman SA, Biousse V, Newman NJ : Stages of improvement in visual fields after pituitary tumor resection. Am J Ophthalmol 130 : 813-820, 2000   DOI
26 Lee JP, Park IW, Chung YS : The volume of tumor mass and visual field defect in patients with pituitary macroadenoma. Korean J Ophthalmol 25 : 37-41, 2011   DOI
27 Levy A : Pituitary disease : presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry 75 Suppl 3 : iii47-iii52, 2004
28 Miller NR : Walsh and Hoyt's Clinical Neuro-Ophthalmology, ed 4. Baltimore : Williams & Wilkins, 1988, pp1433-1484
29 Miller NR, Newman NJ, Biousse V, Kerrison JB : Walsh & Hoyt's Clinical Neuro-Ophthalmology, ed 6. Philadelphia : Lippincott Williams & Wilkins, 2005, pp503-573
30 Monteiro ML, Zambon BK, Cunha LP : Predictive factors for the development of visual loss in patients with pituitary macroadenomas and for visual recovery after optic pathway decompression. Can J Ophthalmol 45 : 404-408, 2010   DOI
31 Musluman AM, Cansever T, Yilmaz A, Kanat A, Oba E, CavuSoglu H, et al. : Surgical results of large and giant pituitary adenomas with special consideration of ophthalmologic outcomes. World Neurosurg 76 : 141-148; discussion 63-66, 2011   DOI
32 Nishimura M, Kurimoto T, Yamagata Y, Ikemoto H, Arita N, Mimura O : Giant pituitary adenoma manifesting as homonymous hemianopia. Jpn J Ophthalmol 51 : 151-153, 2007   DOI
33 Peter M, De Tribolet N : Visual outcome after transsphenoidal surgery for pituitary adenomas. Br J Neurosurg 9 : 151-157, 1995   DOI
34 Powell M : Recovery of vision following transsphenoidal surgery for pituitary adenomas. Br J Neurosurg 9 : 367-373, 1995   DOI
35 Rivoal O, Brezin AP, Feldman-Billard S, Luton JP : Goldmann perimetry in acromegaly : a survey of 307 cases from 1951 through 1996. Ophthalmology 107 : 991-997, 2000   DOI
36 Sivakumar W, Chamoun R, Nguyen V, Couldwell WT : Incidental pituitary adenomas. Neurosurg Focus 31 : E18, 2011
37 Westheimer G : Visual acuity in Kaufman PL, Alm A, Adler FH (eds):Adler's Physiology of the Eye : clinical application, ed 10. St. Louis, MO : CV Mosby, 2003, pp453-469
38 Wilson CB : Surgical management of pituitary tumors. J Clin Endocrinol Metab 82 : 2381-2385, 1997   DOI
39 Zhang X, Fei Z, Zhang J, Fu L, Zhang Z, Liu W, et al. : Management of nonfunctioning pituitary adenomas with suprasellar extensions by transsphenoidal microsurgery. Surg Neurol 52 : 380-385, 1999   DOI
40 Zhang X, Fei Z, Zhang W, Zhang JN, Liu WP, Fu LA, et al. : Endoscopic endonasal transsphenoidal surgery for invasive pituitary adenoma. J Clin Neurosci 15 : 241-245, 2008   DOI